Robert C. Bowman, M.D.
Income - Each year 500 - 700 more students admitted whose parents made more than $100,000 (out of 16000 matriculants). This excludes rural and lower income types. This translates to fewer choosing FP, primary care, primary care poverty, and rural practice each year. The correlation between % admitted who are rural born and % choice of rural practice is 0.86 to 0.92 depending on type of rural definition. Schools admitting more rural born also admit more older, more instate born, more born in lower income counties, and have lower MCAT score averages for the school. (not including atypical and osteopathic schools in MCAT considerations)
Rural born - decreasing steadily from 27% in 1940s to 10% of graduates now.
Foreign born and Asian - foreign born increasing from a few % to 16%, Asian total to 22% or 3500 of 16000 - increasing Asian admissions squeezes out the urban born that share schools and cities as well as the lower income and rural types at the bottom of the socioeconomic scale. There is not a problem with Asian or Foreign born, the problem lies in US schools, education, and families that are not doing what should be done in education.
Ethnicity, gender, admissions, and career choice impact physician distribution. Ethnicity Gender and Rural Practice Choice
White male rural born FPs the most likely to do rural practice and poverty rural practice but also the most likely to do military.
Admissions of whites, males, instate born, and rural born are declining the most rapidly and have been for 20 years - all are factors in choice of family medicine, choice of rural practice, and retention in the same state as the medical school.
Underrepresented minority student admissions increased under the influence of Civil Rights and medical school admissions changes (beyond 3 schools) with a sharp increase from 3 to 8% at the end of the 1960s. This level was maintained despite medical school expansion. Increased sharply in the late 1980s coincident with declines in application pools (as seen below), increased under the influence of 3000 by 2000 and affirmative action to 12% of admissions and declined sharply with impacts of reversals of affirmative action.
Applicant Pool Data from Richard A. Cooper Medical Schools
And Their Applicants: An Analysis Health Affairs, July/August 2003; 22(4):
71-84.
http://content.healthaffairs.org/cgi/reprint/22/4/71 Data on medical school
applicants, matriculants, and graduates were obtained from “Medical Schools in
the United States,” Journal of the American Medical Association 286, no. 9
(2001): 1085–1093 and previous years; Association of American Medical Colleges,
AAMC Data Book: Statistical Information Related to Medical Schools and Teaching
Hospitals (Washington: AAMC, 2002); V.W. Lippard, A Half-Century of American
Medical Education: 1920–1970 (New York: Josiah Macy Jr. Foundation, 1974),
116–117; and W.G. Rothstein, American Medical Schools and the Practice of
Medicine (New York: Oxford University Press, 1987), 142–143. The numbers of
students, graduates, and so forth presented in these various sources were not
always the same, and the figures quoted are attempts to reconcile these
differences.
Ratios of admission go up sharply for usual students, less so for URM students, and slightly for rural born (up to 1500 per year and then back to 1100 and declining slowly again). Older students increase with expansion and also with declines in applicant pools. Instate born student admissions are slowly declining over time. This suggests preference by admissions committees for those born out of state. This also coincides with increases in Asian and Foreign Born admissions and increases in MCAT scores. The bioscience score is up about 0.1 of a point a year or 1 - 1.2 points per decade.
By compiling data by county typology (Ghelfi and Parker) the following admissions levels by county can be determined. The least influenced county types were government counties
Basically the changes appear to have left farming and manufacturing folks in the dust. Education funding based on property values is particularly damaging to lower income and rural areas (Funding Gap 2004). States with wide disparities in education funding tend to have lower family medicine graduation rates (0.4 correlation p <<.05)
This study is limited by the changes in rural demographics as there have been declines in population in counties involved in farming and manufacturing. The changes do not appear to explain all of the differences.
Physician Distribution in the United States
Birth Origins and Distribution Tables